Provider Demographics
NPI:1750520094
Name:BRIARGROVE EYE CENTER, P.A.
Entity type:Organization
Organization Name:BRIARGROVE EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MULDOON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-974-2020
Mailing Address - Street 1:5874 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5641
Mailing Address - Country:US
Mailing Address - Phone:713-974-2020
Mailing Address - Fax:713-975-9756
Practice Address - Street 1:5874 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5641
Practice Address - Country:US
Practice Address - Phone:713-974-2020
Practice Address - Fax:713-975-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217275101Medicaid
TX217275101Medicaid
TX0A6028Medicare PIN